Why Tottenham's Injury Crisis Could Take Years to Fix
On October 18, Roberto De Zerbi confirmed Dejan Kulusevski was set for Tottenham's bench against Coventry City. His return followed medical clearance after more than 500 days out with a knee injury.
For Kulusevski, that is a major step. For Spurs, it raises a harder question. Why has the club struggled to keep players fit for so long?
In 2023-24, Tottenham recorded 37 injuries across 22 players, with 1,402 days lost. 2 In 2024-25, the club had 41 injuries and lost 1,553 days. Only Brighton recorded more injuries that season, while Ipswich matched Spurs' total. The problem continued in 2025-26. Sky Sports counted 370 missed player appearances through injury across all competitions. BBC Sport reported more than 2,000 days lost and average player availability of about 77%.
These sources count injuries in different ways. Their figures cannot show an exact yearly trend. But they establish a problem that has lasted through several managers.
Five findings help explain why a lasting fix may take time. None proves a single cause at Tottenham.
1. An Old Injury Can Raise the Next Risk
Micky Van de Ven returned against Chelsea in December 2024 after six weeks out with a hamstring injury. He left the match in the second half. Tottenham later confirmed another setback. Richarlison also faced repeated problems in 2024-25. He came back from hamstring and groin injuries, then hurt his calf against Liverpool in February. Neither case proves that Spurs rushed a player back.
The wider science helps explain why injury history matters. A 2020 review combined data from 71,324 athletes across several sports. Those with a past hamstring strain faced about 2.7 times the risk of another hamstring injury. The review also found links between past ACL or calf injuries and later hamstring strains.
Those are group findings, not forecasts for Spurs players. But a new season does not reset a player's medical history. Staff can plan for risks that remain after a return.
2. Serious Knee Injuries Create a Backlog
Tottenham has also faced an unusual run of major knee injuries. James Maddison, Wilson Odobert and Xavi Simons suffered tears to the anterior cruciate ligament, or ACL. It helps hold the knee steady. Kulusevski's injury was a different knee problem.
These injuries can take months to recover from. Returning to training does not mean a player is ready for a full match.
A study of 106 people after ACL surgery followed their return to sports that involve sharp turns. Full follow-up data were available for 100. Later returns, up to nine months after surgery, and stronger, more even thigh muscles were linked to fewer new knee injuries.
That study cannot set a date for any Spurs player. It shows why staff have to judge strength and progress, not just days since surgery. Even a better recovery plan cannot give back months already lost.
3. Medical and Coaching Staff Need One Plan
In June 2025, BBC Sport reported friction between Tottenham's coaches and medical and fitness teams. A year later, Sky Sports reported concerns about weak communication and too few shared decisions. Sources believed those gaps had helped cause injuries and repeat injuries. That claim has not been proved for any single player.
Research offers a reason to examine those concerns. A 2025 study of 14 European clubs found that better communication between medical and performance staff was linked to fewer days lost to hamstring injuries. The study found a link, not proof that communication alone prevents injury.
Tottenham's review proposed a more personal approach. That includes player profiles, shared recovery plans and smaller groups assigned to a physiotherapist.
Those plans matter only if coaches use them. If a test shows a player is not ready for hard sprints, his next session can change.
4. Changing Staff Can Break Continuity
Tottenham had four head coaches in roughly one year: Ange Postecoglou, Thomas Frank, Igor Tudor and De Zerbi. Sky Sports reported that their methods placed different demands on the squad.
But changing a manager is not proof of injury risk. A 2023 study tracked 14 European clubs over three seasons. It found a higher hamstring injury burden when clubs changed their fitness coach or team doctor. A change of head coach alone did not show a clear statistical link. That makes the distinction important. The study does not tell us what caused Tottenham's injuries. It does suggest why a stable medical and fitness approach may help when the manager changes.
Spurs can set that approach now. They still have to keep it working through a season of training, travel and matches.
5. The Pitch Is Still an Open Question
Tottenham also tested whether its retractable home pitch played a part. Early comparisons found no major difference from other surfaces, BBC Sport reported. Sky Sports called the results inconclusive, with more tests planned.
The pitch has not been proved to cause the injuries. It has not been fully ruled out either.
Some injuries follow contact or an awkward landing. BBC Sport reported that Odobert tore his ACL after an awkward landing. Maddison warned against blaming every injury on the medical staff or the pitch.
That uncertainty matters. Spurs cannot remove a proven single cause when none has been found.
The Real Test Comes After the Changes
Tottenham wants to raise player availability from about 77% toward 90%. The club knew this would be hard to achieve quickly, BBC Sport reported.
Staff can check some results now. Does every player have a recovery plan? Do coaches and medical staff agree on it? Do fitness tests change what happens in training?
That last point reflects one idea in my upcoming book, Unified Marginal Gains Reference: How Small Wins Compound Into Elite Athletic Performance, now available for preorder. Tracking progress matters only when the results guide decisions.
The larger test takes longer. Spurs can track missed days, repeat injuries and match availability using the same measures each season. One healthy month would not prove much. A better season would be progress. Keeping those gains would provide stronger evidence. This does not mean every change needs years to help. It means long recoveries, past injury risks and new ways of working may take time to overcome. Proving that the gains last takes longer still.
Kulusevski's return is good news. Ending Tottenham's injury crisis means more players staying fit after they return.
Waydell D. Carvalho is a researcher and systems analyst focused on sports governance and performance. He is a performance analyst for Cwmbran Celtic in the Welsh Ardal South East League. He is also the author of American Soccer Cartel: The System Rigged America’s World Cup Chances and creator of Director of Management: Football Club (DOMFC), a football management game on Steam.
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